Sacral nerve stimulation as a treatment for fecal incontinence

Rosén, Harald; Urbarz, Christina; Holzer, Brigitte; Novi, Gabriele; Schiessel, R

doi:10.1053/gast.2001.27120

Cited by 242 publications

(267 citation statements)

References 15 publications

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“…[15][16][17][18][19] However, as described in a recent Cochrane review, large controlled clinical trials are needed to improve treatment of bowel dysfunction in SCI patients. 20 In such studies, radiographically determined colonic transit times [4][5][6][7] or colorectal emptying at defecation 8,28,29 could be used as objective measures of colorectal transport.…”

Section: -14mentioning

confidence: 99%

“…These include the enema continence catheter, 15 the Malone antegrade continence enema administered through an appendicostomy, 15,16 serotonin HT 4 agonists 17,18 and sacral nervous stimulation. 19 However, a recent Cochrane review revealed a great need for larger randomized controlled clinical trails to evaluate the effect of the different treatments. 20 Such trails require objective endpoints -for instance validated standardized symptom-based scores.…”

Section: Introductionmentioning

confidence: 99%

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Neurogenic bowel dysfunction score

et al. 2005

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Study design: Cross-sectional questionnaire study. Objectives: To develop and validate a symptom-based score for neurogenic bowel dysfunction (NBD): NBD score. Setting: University Hospital of Aarhus, Denmark. Methods: A questionnaire including questions about background parameters (n ¼ 8), faecal incontinence (n ¼ 10), constipation (n ¼ 10), obstructed defecation (n ¼ 8), and impact on quality of life (QOL) (n ¼ 3) was sent to 589 Danish spinal cord injured (SCI) patients. The reproducibility and validity of each item was tested in 20 and 18 patients, respectively. Associations between items and impact on QOL were determined by logistic regression analysis. The NBD score was constructed from items with acceptable reproducibility and validity that were significantly associated with impact on QOL. Based on odds ratios for associations between items and impact on QOL, each item was given a corresponding number of points in the NBD score. Results: A total of 424 SCI patients responded. The following 10 items met the criteria above: frequency of bowel movements (0-6 points), headache, perspiration or discomfort before or during defecation (0-2 points), tablets and drops against constipation (0-2 points each), time used for each defecation (0-7 points), frequency of digital stimulation or evacuation (0-6 points), frequency of faecal incontinence (0-13 points), medication against faecal incontinence (0-4 points), flatus incontinence (0-2 points) and perianal skin problems (0-3 points). Differences in NBD score among patients reporting no, little, some or major impact on QOL were statistically significant (all Po0.001). Conclusion: Based on valid and reproducible questions, we have constructed a score for NBD that is correlated to impact on QOL.

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Section: -14mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Neurogenic bowel dysfunction score

et al. 2005

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“…9 In most patients, a regular conservative bowel management is not effective, and during the last decade, several new therapeutic modalities were suggested: prokinetic agents, 10 biofeedback, 11 enema continence catheter, 12 the Malone antegrade continence enema administered through an appendicostomy 13,14 and sacral nerve stimulation. 15,16 To date, there is limited evidence in the literature supporting any bowel management program for NBD. 17 However, a recent randomized controlled trial found that patients treated with the Peristeen Anal Irrigation System (Coloplast A/S, Kokkedal, Denmark) had fewer complaints of constipation, less fecal incontinence, improved symptom-related QoL and reduced time consumption on bowel management procedures compared with patients treated by conservative bowel management.…”

Section: Introductionmentioning

confidence: 99%

Treatment of neurogenic bowel dysfunction using transanal irrigation: a multicenter Italian study

et al. 2008

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Study design: Thirty-six patients with unsatisfactory treatment of neurogenic bowel dysfunctions (NBD) were enrolled from Spinal Units and Rehabilitation Centers in Italy. Treatment was for 3 weeks using a newly developed integrated system with an enema continence catheter for transanal irrigation (Peristeen, Coloplast A/S Kokkedal Denmark). Objectives: To evaluate the effects of Peristeen Anal Irrigation on NBD and patient quality of life (QoL). Setting: Italy. Methods: Lesion level, ambulatory status and hand functionality were determined in all patients. NBD symptoms and QoL were evaluated before and after treatment, using a specific questionnaire. Statistical analysis was performed using McNemar Test and Sign Test. Results: Thirty-six patients were enrolled, and 32 patients completed the study. At the end of the treatment, 28.6% of patients reduced or eliminated their use of pharmaceuticals. Twenty-four patients became less dependent on their caregiver. There was a significant increase in patients' opinion of their intestinal functionality (P ¼ 0.001), QoL score (P ¼ 0.001) and their answers regarding their degree of satisfaction (P ¼ 0.001). A successful outcome was recorded for 68% of patients with fecal incontinence, and for 63% of patients with constipation. Conclusion: Peristeen Anal Irrigation is a simple therapeutic method for managing NBD and improving QoL. It should be considered as the treatment of choice for NBD, playing a role in the neurogenic bowel analogous to that of intermittent clean catheterization in bladder treatment.

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“…La NRS es una terapia de reciente desarrollo y la bibliografía acerca de esta no es extensa (9). Las series publicadas, todas ellas con escaso número de pacientes, muestran resultados similares en cuando a índices de eficacia en torno al 70% (13)(14)(15)(26)(27)(28). En nuestra serie, la NRS ha supuesto una reducción media del valor de continencia en la escala de continencia de Cleveland-Wexner del 67,53%, resultado equiparable a los objetivados por otros grupos.…”

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Neuromodulación de raíces sacras como tratamiento de la incontinencia fecal: Resultados preliminares

Navarro

Sebastián

Vicente

et al. 2007

Rev. esp. enferm. dig.

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INTRODUCCIÓNLa incontinencia fecal (IF) se define como la incapacidad de diferir la defecación hasta que se encuentra el lugar y el momento socialmente idóneos para realizarla, produciéndose una pérdida recurrente e involuntaria de material fecal o gases a través del canal anal. Aún en los casos más leves de IF (en donde únicamente se producen escapes y ensuciamientos de la ropa interior), esta patología conlleva en mayor o menor medida problemas físicos, psicológicos y alteraciones en la calidad de vida de los pacientes (en los ámbitos sexual, familiar, social y laboral) (1-3). Vol. 99. N.°11, pp. 636-642, 2007 Recibido: 20-05-07. Aceptado: 10-09-07. RESUMENPresentamos nuestra experiencia inicial en el tratamiento de la incontinencia fecal (IF) mediante neuromodulación de raíces sacras (NRS), a través de los resultados de un estudio prospectivo realizado con 26 pacientes en el que se comparan los valores basales en la escala de continencia de Wexner-Cleveland y en la capacidad para el retraso de la defecación, con los obtenidos tras un año de terapia con NRS. El estudio inicial de cada paciente incluía anamnesis, exploración general, ecografía y manometría rectal, así como unos diarios de continencia y de calidad de vida específicos para la IF de 3 semanas. Antes de la terapia con NRS, el valor medio en la escala Wexner-Cleveland fue de 15,00 ± 1,81 y el 62,50% de los pacientes tenía una capacidad de retraso de la defecación menor de 1 minuto. Tras un año de terapia con NRS, el valor medio en la escala de Wexner-Cleveland fue de 4,87 ± 2,54 (p = 0,0031) y el 75,01% de los pacientes presentaba una capacidad de retraso defecatorio mayor de 15 minutos (p = 0,0018). Hacemos, además, una descripción detalla de la técnica quirúrgica de la NRS, haciendo referencia a sus indicaciones y finalizamos revisando las distintas opciones terapéuticas para la IF mostrando nuestro algoritmo terapéutico para esta patología. La NRS es una técnica eficaz para el tratamiento de la IF en pacientes seleccionados que no han respondido a tratamiento conservador, biofeedback o correcciones anató-micas (esfinteroplastia), con una mínima morbilidad y susceptible de realizarse en un programa de cirugía ambulatoria.Palabras clave: Incontinencia fecal. Neuromodulación. Raíces sacras. ABSTRACTWe present our initial experience in the treatment of fecal incontinence (FI) with sacral root neuromodulation (SRN) by reporting the results of a prospective study with 26 patients where baseline Wexner-Cleveland scale scores and ability to delay defecation were compard to results after one year with SRN. The initial study of patients included history taking, general examination, anal ultrasonography, and manometry, and a three-week diary of continence and quality of life specific for FI was used. Before SRN the mean baseline Wexner-Cleveland score was 15.00 ± 1.81, and 62.50% of patients could only delay defecation for less than a minute. After a year with NRS the mean Wexner-Cleveland score was 4.87 ± 2.54 (p = 0.0031), and 75.01% of patients coul...

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Sacral nerve stimulation as a treatment for fecal incontinence

Cited by 242 publications

References 15 publications

Neurogenic bowel dysfunction score

Neurogenic bowel dysfunction score

Treatment of neurogenic bowel dysfunction using transanal irrigation: a multicenter Italian study

Neuromodulación de raíces sacras como tratamiento de la incontinencia fecal: Resultados preliminares

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